Journal of Otology & RhinologyISSN: 2324-8785

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Case Report, J Otol Rhinol Vol: 2 Issue: 2

The Case of Laryngeal Lipoma

Guclu O1*, Muratlı A2, Barutcu O1 and Derekoy FS1
1Department of ENT, Faculty of Medicine, Canakkale Onsekiz Mart University, Terzioglu Yerleskesi, Canakkale, Turkey
2Department of Clinical Pathology, Faculty of Medicine, Canakkale Onsekiz Mart University, Terzioglu Yerleskesi, Canakkale, Turkey
Corresponding author : Oguz Guclu
Department of ENT, Faculty of Medicine, Canakkale Onsekiz Mart University, Terzioglu Yerleskesi, Canakkale, Turkey
Tel: +905422707866
E-mail: [email protected]
Received: November 15, 2012 Accepted: March 28, 2013 Published: March 31, 2013
Citation: Guclu O, Muratli A, Barutcu O, Derekoy FS (2013) The Case of Laryngeal Lipoma. J Otol Rhinol 2:2. doi:10.4172/2324-8785.1000114

Abstract

The Case of Laryngeal Lipoma

Laryngeal lipoma is a pathology that is quite rarely encountered. Within laryngeal benign tumors, it has an incidence of approximately 1%. Lesions, big ones, may necessitate a tracheotomy due to causing obstruction of the respiratory tract or making intubation difficult. In this study, the case of a 64-year old man with laryngeal lipoma is discussed. The lesion was 2 x 1.5 centimeters on the aryepiglottic fold and presented as a stalked and dynamic mass. The patient received a direct laryngoscopy, without needing a tracheotomy.

The histopathology of laryngeal lipoma cases, clinical evaluation and approaches to treatment will also be discussed.

Keywords: Larynx; Lipoma; Laryngeal lipoma; Benign laryngeal tumor

Keywords

Larynx; Lipoma; Laryngeal lipoma; Benign laryngeal tumor

Introduction

Laryngeal lipomas are rare benign mesenchymal tumors. About 120 larynx and hypopharynx lipoma cases have been presented in the English literature. Zakrzweski states that the number of cases known by 1965 was 70 [1]. As tumors, laryngeal lipomas take their source from adipose tissue; however, they may sometimes contain components of connective tissue (fibrolipoma), proliferated blood vessels (angliolipoma), or bone marrow (myelolipoma). Laryngeal lipomas are generally observed as isolated lesions and are not associated with systematic lipomatosis. This slow-growing tumor causes claims of chronic dysphagia, dyspnea, and hoarseness. It can appear as stalked, broadly-based, or deeply-located.
In this article, a rare laryngeal tumor case is examined. Its diagnosis and treatment are discussed in accordance with the literature.

Case Report

A 64 year-old male patient admitted to our clinic complained of changes in his voice, dyspnea, and globus sensation. The symptoms had progressive course and become more prominent during the last year. A stalked, yellow-colored, smooth-surfaced, dynamic mass on the right aryepiglottic fold is found by videolaryngoscopic examination (Figure 1). The closure of rima glottis is sometimes blocked by movement of mass (Figure 2). Direct laryngoscopy under general anethesia was planned and during the operation, a submucosal solid mass was noticed. A lesion with a thin fibrotic capsule was excised by cold dissection. Benign laryngeal lesion was considered and extirpated completely from the larynx. Histopathological investigation revealed the diagnosis as lipoma. With wide polygonal cytoplasm, mature adiposities located on the periphery of the nucleus were observed. Few vascular structures, observed with few erythrocytes, were detected in its lumen. There were no cellular atypia, necrosis, or calcification in the sections (Figure 3). Patient has no tumor induced symptoms after two year follow-up.
Figure 1: Laryngeal lipoma on aryepiglottic fold.
Figure 2: Extension to rima glottis.
Figure 3: The histopathological image of Laryngeal Lipoma.

Discussion

Lipoma is the most common mesenchymal benign tumor. Twenty-five percent of all lipoma cases are found around the head and neck. Laryngeal benign tumors occur approximately at an incidence rate of 1%. Generally, lipomas are located in the supraglottic area, but they are sometimes (rarely) found in the subglottic area [1-4]. They are divided into two groups – extrinsic and intrinsic lipoma. The extrinsic ones are, in most cases, localized on the laryngeal ventricle and are stalked superficial. The intrinsic ones are frequently deeply localized as submucosal on the ventricular band [4]. Until now, no case has been reported of lipoma within the histological structure of the vocal cords [5].
Laryngeal lipomas are frequently pedunculated, single and straight-surfaced lesions. In direct and indirect laryngoscopies, they appear yellow and gray. The extrinsic ones especially are dynamic lumps. Prominent clinical symptoms are difficulty swallowing, dyspnea, and voice change. Large, stalked lesions may lead difficult intubation. Miloudi et al. also reported a case accidentally realized during intubation [6]. Large and stalked lesions depending on their movement may create respiratory distress by blocking the rima glottis. This situation may even require an emergency tracheotomy. Lecleire et al. have reported a case in which asphyxia was developed and a tracheotomy performed during the esophagus endoscopy [7]. In this case, a stalked lipoma that stemmed from the aryepiglottic fold sometimes led to respiratory distress by blocking the rima glottis. Complaints about difficulty swallowing, hoarseness, and dyspnea were also present in our case. In the video laryngoscopy examination, a stalked and dynamic mass lesion on the aryepiglottic fold was detected. Even though the mass’s movement toward the rima glottis did not completely block the respiratory passage, it sometimes created a mild dyspnea. However, a tracheotomy was not required and performed.
Benign lipomatous lesions can be subcategorized according to their growth pattern (single or multiple) and histological structure. Fibrolipoma, angiolipoma, intramuscular lipoma, pleomorphic lipoma, lipoblastomatosis, and diffuse lipoblastomatosis are examples of types of these lesions. All include mature adipose tissue that differs, however, from normal adipose tissue and exhibits inappropriate metabolic transformation. Benign lipomatous lesions are also surrounded by a thin fibrous capsule [8]. However, they must be distinguished from liposarcoma. Cellular pleomorphism and multivacuolar lipoblasts, rich in vascularization and prominent mucoid matrix, are confirmed by pathological examinations of liposarcoma, which may be mistaken for a variant of spindle cell liposarcoma.
The most common superficial lipoma location is the posterior triangle. However, it may also found in the anterior neck area, the parotis, the oral cavity, the larynx, the hypopharynx, and the retropharyngeal area. Diagnosis of deeply-located lesions may be difficult. At this point, imaging methods are quite helpful to clinicians. Computerized tomography and magnetic resonance imaging may be preferred. Both provide sufficient information for diagnosis. Adipose tissue is observed as Hounsfield Unit (HU) within densities of -64 to -123. The presence of some histological subgroups (such as spindle cell lipoma, pleomorphic lipoma, and infiltrative lipoma) may make differential diagnosis confusing, as these are similar in appearance to well-differentiated liposarcoma [8-10]. In such cases, imaging can show changes that are considered sarcomatoid degeneration, including abnormal tumor margins and irregular vascularization [8].
The treatment for laryngeal lipoma is surgical excision of the lesion. The first choice is by endoscopic methods. External surgery is necessary for large lesions that cannot be extracted. Thyrotomy, lateral pharyngotomy or anterior pharyngotomy may be preferred. The method is chosen according to the location of the lesion and the surgeon’s experience. Recurrence is usually due to incomplete excision. In addition the possibility of liposarcoma should be considered in cases with recurrence.

Conclusion

Laryngeal lipoma is a rare tumor of larynx. It is usually a submucosal, yellow-gray, straight-surfaced, generally stalked, and single supraglottic lesion. Usual symptoms are voice change, dyspnea and difficulty swallowing. Imaging methods are quite effective for differential diagnosis. However, prompt diagnosis is based on histopathology.

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